Summary of Post-Event Communication = Leadership

SUMMARY OF POST-EVENT COMMUNICATIONS = LEADERSHIPOver the past few weeks, I've written about key factors to consider when dealing with upset patients and grieving families post-advese event. We've talked about empathy, the need for witnesses, and how to avoid mush statements (see below this newsletter for past newsletters, in case you missed them).

I've hope you, our readers, have gained value from these insights, and I've refined/honed my own thinking in delivering these Enewsletters to you. I think all of this post-event stuff can be summarized with one word: Leadership! Good ol' fashioned leadership. Patients and families desperately need leadership post- adverse from their front-line clinicians and staff. They need to see and feel people who are not only in the trenches with them, but able and willing to show the way out of the trenches. "I am your doctor...I am your nurse....and we are going to get through this together. I will never leave your side. We are a team. I am sorry this happened, but we will get through it."

Leadership!

It's no secret, however, for far too long, front-line staff and the people who support them (risk, legal, c-suite) have shown too little leadership to patients and families post-event. Hushed conversations is not leadership. Only talking to the lawyers is not leadership. Avoiding patients and families is not leadership. Folks, we don't have a med-mal crisis in this country, we have a leadership crisis post- event! Medical people by and large fail to lead after something goes wrong. It's as if the Marines packed up and went home when the fighting gets a little tough. Thank God our soldiers don't quit when things go bad, but physicians, nurses, and their support people (c-suite, legal, risk, etc) quit every day on patients and families when things go wrong. Every day! Subsequently, upset patients and grieving families have sought leadership from - surprise, surprise! - lawyers, the media, regulators, etc.

When it comes to post-event communication and disclosure, we need to make our front-line staff the leaders needed by patients and families. But, in the words of Vince Lombardi, "Leaders aren't born, they are made. And they are made just like anything else, through hard work. And that's the price we'll have to pay to achieve that goal, or any goal."

Coach Lombardi is telling us we need to train and empower our front- line people. Disclosure training is no longer optional - it's as essential as anything else in healthcare. And Sorry Works! can help. For more information on Sorry Works! presentations and disclosure training, contact 618-559-8168 or e-mail doug@sorryworks.net.

This is our second installment in the typical pitfalls and problems with empathizing (first installment is directly below). Common mistakes and problems encountered by healthcare professionals trying to do the right thing by everyone - including themselves - post event. Mush statements are a big problem. They lack clarity and don't calm the nerves of upset patients and families. In fact, these statements increase anxiety and chances of litigation because, well, they are...er...mushy!

"Mom, what did the doctor mean when he said he will 'look into it,' and when exactly is he going to get back to us?"

Try this for clarity: "I'm sorry the operation did not work out as we expected, we are investigating to learn what happened, and we will touch base with you again to share what we've learned at 3pm tomorrow afternoon. In the meantime, if you have any additional questions or want to share information with me, here is my card with my cell phone number on it...please call anytime. Again, I am sorry this happened, but we are going to get through this together."

Nothing mushy there! Clarity is so important when you are dealing with emotionally traumatized people. Such people are looking for leaders, looking for solid rocks to tie their leaky boats to. Be that rock with your words and actions! Give these folks leadership, or they might seek leadership from other people, including a lawyer! The choice is yours!

And don't fall into another trap....3pm tomorrow comes and your investigation hasn't learned much if anything at all, so you don't contact the patient or family as promised but instead wait until you have something meaningful to report. WRONG! Because what's happening to the patient or family when you skip the promised 3pm meeting? First, they will get anxious. Real anxious! Then the thoughts, doubts and questions will start swirling through their minds..."Where is the doctor? She promised to meet with us again! Is the doctor afraid to tell us something? Is it worst then we expected? Did the lawyers tell her not to talk? Should we get our own lawyer?" And then the loudmouth uncle from California will start saying he never trusted that doctor or the nurses in the first place, he just called that lawyer on the back of the phone book, and a meeting is scheduled first thing tomorrow morning. You now officially have problems.

Try the following, instead: "Mrs. Jones, it's 3pm and I did promise to touch base with you again. We don't have the answers yet, but I can tell you how the investigation is proceeding, who we are talking with, the information we are gathering, and we will meet again with you tomorrow at 3pm, if that is convenient for you and your family. Also, while we are talking, I would like to hear if you have any more questions or have additional information you can share with us?"

WHEN EMPATHIZING, TAKE A WITNESS...
When I give a Sorry Works! presentation, I always have four slides I call the empathy example:

"Mrs. Jones, the surgery is over, and I know you were looking forward to taking your Mom home in a few days. You have that big birthday with the grandkids next weekend. Well, I'm sorry to tell you she's in the ICU...the operation didn't work out as we hoped. I can only imagine how scary this must be for you, and I'm sorry. Please understand, we've already launched an investigation to learn what happened and will touch base with you again by 3pm tomorrow afternoon to update you with our progress. Also, understand, your Mom is receiving the best care possible and we are going to keep you posted on her progress and we are always ready to answer any questions. In the meantime, is there anything I can do for you now? Food, transportation, phone calls, lodging? Do you need a minister? Here's my business card....that phone number is actually my cell phone. Call anytime if you have questions or simply need more help. Again, I'm very sorry this happened, but we're going to get through this together."

The empathy above - not apology! - is provided as soon as possible after the adverse event. What you're not seeing in that quote/statement is a witness. Take a witness....your partner, a trusted nurse, someone - to help with the documentation of the event. Again, as we've always said, disclosure at the minimum is about creating great evidence for a strong defense (if needed). And you have to think that a patient or family who is learning for the first time that they have just become a statistic may not hear everything you are saying. In fact, they may remember little or nothing of what you say! So, have a witness from your side, and you and your witness must make sure the chart is documented accurately after every conversation with the patient or family. Just the facts....no emotion, speculation, derogatory remarks, etc. Simply we talked with the Jones family at 2pm Tuesday afternoon, discussed the following items, note any comments or questions from the patient or family, and promise to touch base again with a specific time/date. Just stick to the facts, please! You may also consider sending a follow up letter to the patient or family. But always have that witness!!